Non-binary Gender Identities

The number of patients with a non-binary gender identity requesting access to Gender Identity Services in the UK is on the rise.

‘Non-binary’ is often used as an umbrella term by people whose gender identity is something other than the binary option of ‘male’ or ‘female’.  It may be somewhere between male and female, or occupy a third, separate category. It may be fixed or fluid, singular or multiple.

Non-binary identities include genderqueer (a connotation of non-conforming gender expression), agender (gender is neutral or absent), genderfluid (gender shifting over time), and bigender (two gender identities). Ask your patient how they identify and consider what this means when having to navigate a binary society. The most popular pronouns used by this group are ‘they/them’, but don’t assume, as there are others such as ‘ze/hir’. It is vital to ascertain pronouns in order not to inadvertently misgender your patient when referring to them either in writing, or in dialogue with other healthcare staff.

Some non-binary people assigned female at birth seek bilateral mastectomy with chest reconstruction surgery, and no cross-sex hormone therapy. For others, a low dose of testosterone helps them achieve a closer approximation to their internal identity from a physical and psychological perspective. In a similar way, low dose oestrogen therapy or an androgen-blocker might be suited to some people assigned male at birth, particularly some non-binary people. This is covered in the module on transgender health.

Changing personal details on the medical record is straightforward, and no special permission or process is needed. Being under the care of a Gender Identity Clinic or holding a GRC (Gender Recognition Certificate) is not a requirement. 

With a signed letter from the patient and either a deed poll or a statutory declaration (although neither are obligatory) the surgery administrator can start the process. Mx is often a preferred title, and gender marker options are “unspecified” or “unknown”, although these should not be assumed to be desired by non-binary people. Some may wish to keep the marker associated with birth assignation, others may wish to use the marker associated with the other binary option. Patients should be informed that their gender marker may change the notifications they receive for national screening programmes.

The UK does not legally recognise a third gender category, so at present this cannot be reflected on a birth certificate, passport or driving licence. At this current time, the Gender Recognition Act 2004 does not include non-binary people, and it is therefore not possible for them to acquire a Gender Recognition Certificate that matches their acquired gender. They may still decide to apply for one, as being recognised/positioned as the ‘other’ binary gender may be preferable.

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